Look for something better to rise from the rubble.

Earlier this week, my friend and colleague Terry Boyle of Insider Louisville gave us all a heads-up that the Kentucky Medicaid Cabinet would be announcing the results of its search for additional Medicaid Managed Care Organizations (MCOs) to operate in Kentucky’s Region 3 in Jefferson and surrounding 15 counties. This prediction was spot-on. Today the Commonwealth announced it had finalized contracts with four MCOs that will begin services January 1, 2013. This is big news, and must have been a terrible disappointment for Passport and the University of Louisville.

Passport has been operating under a special Federal dispensation that permitted it to have a monopoly for the past 15 years to provide clinical care to Medicaid beneficiaries in region 3. For reasons not entirely known to me (but that I can guess) that privilege has been revoked. In less than three months, Passport will be joined by Coventry Cares, Wellcare of Kentucky, and Humana. No doubt there is much scrambling going on to assemble provider networks of hospitals and healthcare workers. Coventry Cares and Wellcare already have statewide networks of Medicaid providers, and Humana has extensive local private and Medicare networks that it may be able to call into service for Medicaid beneficiaries. In fact, Passport is lucky it has not been asked to provide a statewide network as previous MCOs were required to do. This would likely have sunk Passport and seems to me to be a major concession to them. Continue reading “A Grenade Explodes in Jefferson County’s Medicaid Managed Care.”

Are different MCOs treated differently by the state?

Terry Boyd at Insider Louisville has been out front in reporting on the emerging lawsuits by at least one major Medicaid provider against at least two Medicaid Managed Care Organizations (MCOs) that are handling Medicaid managed care for the Commonwealth. Thank you! I have already expressed my opinion that these suits are like canaries in the cage telling us that something is very wrong with the health of Medicaid in the state and by implication, for the health of Medicaid beneficiaries, medical providers, and those who finance the system. Keep it up!

I am still confused by the nature and details of the claim by Coventry that they were treated differently than at least one other MCO by the state in terms of their requirement to have Appalachian Regional Healthcare (AHS) in their provider network. (I too assumed that the “other” was Kentucky Spirit, but Mr. Nolan of Coventry seems careful not to name the other organization.) From their lawsuit against Kentucky Spirit (KS), it appears that ARH opted not to sign a full provider contract with KS that would have required it to accept the payment rates of KS as well as other contractual agreements. That would make ARH an out-of-network provider for KS. Despite this, KS continued to authorize and therefore agreed to pay for at least some patient services from ARH. Continue reading “Medicaid Managed Care Lawsuits: Further Thoughts”